Abstract
Background:
Decreased postpartum rotational thromboelastometric parameters of coagulation (ROTEM®) and fibrinogen levels have been associated with postpartum hemorrhage (PPH). However, the predictive power of prepartum ROTEM® parameters and fibrinogen levels (Fbgpre) for PPH remains unknown.
Methods:
This prospective observational pilot study included 217 healthy pregnant women. Maximum clot firmness (FIBTEM-MCF), fibrinogen levels and standard coagulation parameters were measured upon admission to the delivery room for labor and within 1 h after vaginal delivery. Blood loss was measured with a calibrated collecting drape during the third stage of labor. PPH was defined as blood loss ≥500 mL. Predictors for bleeding were identified via receiver operating characteristic analyses and bivariate and multivariate regression analyses.
Results:
Women with and without PPH did not differ in median FIBTEM-MCF [23 mm (25th percentile 20 mm, 75th percentile 26 mm) vs. 23 mm (19 mm, 26 mm), respectively; P=0.710] or mean Fbgpre (4.57±0.77 g/L vs. 4.45±0.86 g/L, respectively; P=0.431). Blood loss and prepartum coagulation parameters were not correlated (FIBTEM-MCF, rs=−0.055, P=0.431; Fbgpre, rs=−0.017, P=0.810). The areas under the curves (predictive power for PPH) for FIBTEM-MCF and Fbgpre and were 0.52 (0.41–0.64, P=0.699) and 0.53 [95% confidence interval (95% CI) 0.40–0.65, P=0.644], respectively. Neither FIBTEM-MCF nor Fbgpre was associated with PPH. However, primiparity [odds ratio (OR) 4.27, 95% CI 1.32–13.80, P=0.015) and urgent cesarean section (2.77, 1.00–7.67, P=0.050) were independent predictors of PPH.
Conclusions:
ROTEM® parameters, Fbgpre and postpartum blood loss were not associated, nor did these factors predict PPH. Sufficiently powered prospective studies are needed to confirm these results.
Disclosure of funding: This paper describes an investigator-initiated study. Support was received from institutional and departmental sources.
Trial registration: DRKS00005624 (www.drks.de).
Conflict of interest statement: C.v.H.: received a speaker’s fee from CSL Behring and TEM International. A.F.: received a speaker’s fee from NOGGO. The remaining authors report no conflict of interest.
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The authors stated that there are no conflicts of interest regarding the publication of this article.
Article note:
Presented in poster format at EUROANAESTHESIA 2014, Stockholm, Sweden, May 31-June 3, 2014.
©2017 Walter de Gruyter GmbH, Berlin/Boston
